【正文】 rged 第六十四頁(yè)，共八十七頁(yè)。 USC BLADDER CANCER EXPERIENCE “Radical cystectomy remains the preferred form of definitive therapy for invasive bladder cancer.〞 第六十五頁(yè)，共八十七頁(yè)。 第六十六頁(yè)，共八十七頁(yè)。 USC BLADDER CANCER EXPERIENCE Reality “There is a significant error in clinical staging of invasive bladder cancer.〞 第六十七頁(yè)，共八十七頁(yè)。 PRIMARY TREATMENT GOALS OF MUSCLE INVASIVE BLADDER CANCER ? Patient survival ? Prevent consequences of pelvic progression/recurrence ? Prevent consequences of metastatic disease 第六十八頁(yè)，共八十七頁(yè)。 USC BLADDER CANCER EXPERIENCE Complications by Adjuvant Therapy 第六十九頁(yè)，共八十七頁(yè)。 BLADDER CANCER: INDICATIONS FOR RADICAL CYSTECTOMY ? Muscle invasive tumor 第七十頁(yè)，共八十七頁(yè)。 BLADDER CANCER: INDICATIONS FOR RADICAL CYSTECTOMY ? Muscle invasive tumor ? High grade tumor with cis 第七十一頁(yè)，共八十七頁(yè)。 BLADDER CANCER: INDICATIONS FOR RADICAL CYSTECTOMY ? Muscle invasive tumor ? High grade tumor with cis ? cis unresponsive to intravesical therapy 第七十二頁(yè)，共八十七頁(yè)。 BLADDER CANCER: INDICATIONS FOR RADICAL CYSTECTOMY ? Muscle invasive tumor ? High grade tumor with cis ? cis unresponsive to intravesical therapy ? Recurrent multifocal high grade tumors unresponsive to intravesical therapy 第七十三頁(yè)，共八十七頁(yè)。 BLADDER CANCER: INDICATIONS FOR RADICAL CYSTECTOMY ? Muscle invasive tumor ? High grade tumor with cis ? cis unresponsive to intravesical therapy ? Recurrent multifocal high grade tumors unresponsive to intravesical therapy ? Endoscopically uncontrollable tumors 第七十四頁(yè)，共八十七頁(yè)。 BLADDER CANCER: INDICATIONS FOR RADICAL CYSTECTOMY ? Muscle invasive tumor ? High grade tumor with cis ? cis unresponsive to intravesical therapy ? Recurrent multifocal high grade tumors unresponsive to intravesical therapy ? Endoscopically uncontrollable tumors ? Tumors associated with a diverticulum 第七十五頁(yè)，共八十七頁(yè)。 第七十六頁(yè)，共八十七頁(yè)。 USC/NORRIS BLADDER CANCER EXPERIENCE (6/7112/97) 第七十七頁(yè)，共八十七頁(yè)。 第七十八頁(yè)，共八十七頁(yè)。 PelvicIliac Lymphadectomy 第七十九頁(yè)，共八十七頁(yè)。 PelvicIliac Lymphadectomy 第八十頁(yè)，共八十七頁(yè)。 USC/Norris Lymph Node Positive Bladder Cancer Experience Primary Bladder Tumor 第八十一頁(yè)，共八十七頁(yè)。 USC/Norris Lymph Node Positive Bladder Cancer Experience Pathologic Subgroups ? Organ confined 75 patients (31%) ? Extravesical 169 patients (69%) ? Cis present in 153 patients (63%) 第八十二頁(yè)，共八十七頁(yè)。 RISK FACTORS FOR PATIENTS WITH PELVIC LYMPH NODE METASTASES FOLLOWING RADICAL CYSTECTOMY John P. Stein, Peter Clark, David A. Ginsberg, Gus Miranda, Susan Groshen, Jie Cai, Gary Lieskovsky and Donald G. Skinner University of Southern California, Norris Comprehensive Cancer Center, Los Angeles CA 第八十三頁(yè)，共八十七頁(yè)。 第八十四頁(yè)，共八十七頁(yè)。 USC/Norris Lymph Node Positive Bladder Cancer Experience Benefits of Pelvic Iliac Lymphadenectomy Provides accurate pathologic staging May provide therapeutic benefits Assists in a safe anatomical dissection 第八十五頁(yè)，共八十七頁(yè)。 Treatment of High Grade Invasive Bladder Cancer Radical Cystectomy ? Extended BPLND ? Pathologic staging ? 25% node + disease ? 33% longterm survival ? Highrisk group Rick Factors LN+ ? P Stage ? lymph nodes involved (tumor burden) ? lymph nodes removed (extent BPLND) 第八十六頁(yè)，共八十七頁(yè)。 內(nèi)容總結(jié) The Role of Lymphadenectomy in Bladder Cancer。 (6/7112/97)。 (6/7112/97)。Prognostic Factors RR pValue。 Prognostic Factors RR pValue。Gender (Female vs. Male) 。 P Stage 第八十七頁(yè)，共八十七頁(yè)。